Indiana redrew its payer map for 2026. Your cardiology claims have to keep up.
Cardiology-specific billing, coding, claims management and revenue cycle support for cardiovascular practices across Indiana delivered by a nationwide team headquartered in Dearborn, Michigan that works exclusively in cardiology. This is what's actually different about billing an Indiana claim, not a national page with the state name swapped in.
Four Medicaid programs, not one fee-for-service system
Indiana Medicaid is administered by the Family and Social Services Administration (FSSA) through its Office of Medicaid Policy and Planning, and it runs four managed care programs each with its own managed care entities, claims addresses and authorization portals.
Coverage for low-income adults.
Children and pregnant members.
Aged, blind and disabled members.
Medicaid members 60 and older.
As of January 1, 2026, MDwise exited as an MCE for HIP and Hoosier Healthwise, leaving Anthem, CareSource and Managed Health Services (MHS) to absorb those members. A patient whose HIP coverage you verified in 2025 may now bill an entirely different MCE with a different claims address, portal and lookup tool. Diagnostic and procedural cardiology work echocardiograms, stress tests, Holter and event monitoring, cardiac catheterization is exactly where prior authorization rules diverge between programs.
Cardiology complexity, plus an Indiana layer on top
The cardiology part
A single visit can generate an E/M service, an in-office echocardiogram with separate technical and professional components, and a same-day decision to schedule a stress test each with its own modifier logic, medical-necessity criteria and authorization requirement.
Interventional work such as diagnostic and therapeutic catheterization brings bundling edits and multiple-procedure reductions. Performed in a hospital outpatient setting, professional and facility coding has to line up or the two claims won't reconcile.
The Indiana part
PA requirements aren't uniform across Indiana's Medicaid programs. IHCP training materials confirm PA criteria can differ between HIP and Hoosier Healthwise for the same service, with each MCE running its own lookup tool.
A practice billing across all four programs is effectively working from several distinct authorization rulebooks not one statewide standard. Which MCE, which MAC, and which criteria set applies changes what "authorized" even means for a given claim.
The prior-authorization clock, now set by statute
SEA 480 put defined turnaround times on prior authorization statewide. Authorization for a nuclear stress test or diagnostic catheterization now moves on a fixed clock and a denial that misses the rules may be worth challenging on procedural grounds alone.
Same-specialty review. Denials must be reviewed by a physician in the same or similar specialty not resolved solely by an algorithm. A denial issued without cardiology review can sometimes be challenged on that basis alone.
Electronic intake. MCEs were required to accept PA requests electronically, phased in through October 2025 changing how requests and appeals are submitted and tracked.
Specialty-focused billing, applied to Indiana's payers
The same cardiology-only services we provide nationwide, mapped onto Indiana's Medicaid MCEs, its MAC and its revised PA rules.
Cardiology medical billing
The full claim lifecycle for diagnostic, interventional and device-related services, with eligibility and prior authorization handled ahead of procedures that require it.
Cardiology coding
CPT, ICD-10-CM and HCPCS coding built around medical necessity and modifier accuracy including the technical/professional splits common in echo, nuclear and stress testing.
Revenue cycle management
Charge capture, coding, claims, denial resolution, posting and A/R follow-up as one connected process whether a claim routes through Anthem, CareSource, MHS, UnitedHealthcare, Humana or WPS.
Claims submission & tracking
Claims prepared, scrubbed and submitted electronically, then tracked through each payer's system so rejections get corrected before they become denials.
Denial management
Denied claims traced to a root cause and pursued for correction or appeal addressing the underlying pattern so it doesn't recur.
Payment posting
Payments reconciled against contracted rates so underpayments get flagged and pursued not absorbed quietly into the ledger.
Two Indiana changes that hit cardiology hardest
Cardiovascular disease concentrates in an older population, which is exactly where Indiana's 2026 payer changes land.
Indiana PathWays Dual Care
A fully integrated Medicare–Medicaid special needs plan for Hoosiers 60 and older who qualify for both programs administered exclusively through three plans contracted with FSSA and CMS. Medicare and Medicaid benefits for the same heart failure or arrhythmia patient are now billed through one integrated plan instead of two, replacing the prior patchwork of coordination-only dual-eligible plans.
Confirming which of the three a patient carries rather than assuming traditional Medicare-plus-Medicaid billing still applies is now a necessary intake step for any sizable geriatric cardiology panel.
Fee-for-service PA structure
IHCP contracts with Acentra Health as its FFS prior authorization vendor, an arrangement now aligning with the CMS Interoperability and Prior Authorization Final Rule several provisions of which took effect January 1, 2026.
Medical-necessity reviews draw on InterQual or MCG (Milliman Care Guidelines) criteria plus MCE-specific policy not one statewide cardiology coverage manual. A catheterization or nuclear study authorized under one MCE's criteria isn't automatically authorized the same way under another.
Much of Indiana's cardiology care runs through large hospital-affiliated groups systems such as IU Health and Ascension St. Vincent operate multi-county cardiovascular programs statewide. CPT and ICD-10-CM coding stays national, but that raises the stakes on clean claim submission for independent groups competing against hospital-employed programs.
The billing problems we see most in Indiana
Most connect directly to this year's payer transitions.
Stale eligibility check
An MCE assignment changed with the MDwise transition or a new PathWays Dual Care enrollment, and the claim comes back as a coverage-not-found rejection rather than a clean denial.
Prior authorization mismatch
A stress test or Holter monitor authorized under one plan's criteria doesn't carry over when coverage changes and under SEA 480, a denial without specialty review can be challenged.
Modifier errors on imaging
Technical and professional component splits on echocardiography and nuclear imaging claims remain a frequent, correctable source of denials.
Repeat-imaging medical necessity
A follow-up echo ordered sooner than a payer's frequency guideline expects needs documentation tying the repeat study to a specific clinical change not a scheduling pattern.
Professional / facility mismatch
For procedures in a hospital outpatient department, mismatched coding between the professional and facility claims can trigger a denial on one side even when the other pays cleanly.
Our cardiology revenue cycle, step by step
The same structure we run nationwide with the difference showing up in the Indiana-specific details.
Eligibility verification
We confirm not just active coverage but which specific MCE, dual-eligible plan or commercial payer is on file for that date of service a step that carries extra weight given how many Indiana patients changed plans this year.
Charge capture & coding review
Cardiology-specific CPT, ICD-10-CM and HCPCS coding, with documentation checked against the payer's medical-necessity criteria before a claim goes out.
Claims submission & tracking
Claims sent electronically and monitored through each payer's system, catching rejections early rather than after they age.
Payment posting
Payments applied against contracted rates, with underpayments flagged for follow-up.
Denial analysis & appeals
Denials traced to root cause an authorization mismatch, a modifier gap, a medical-necessity dispute and pursued against each entity's documented turnaround requirements, including the timelines set under SEA 480.
A/R follow-up & reporting
Aging claims kept moving, with visibility into where revenue is delayed and why.
Subspecialties and procedures we support
Our coders and billers work across the cardiology subspecialties Indiana practices most often bill for and the procedures most often flagged for review under the state's current criteria.
Subspecialties
Procedures
Talk to our cardiology billing team
Dealing with denials tied to a Medicaid MCE transition, adjusting to the SEA 480 changes, or just want a second look at how cleanly claims move through Indiana's payers? We support Indiana practices as part of nationwide coverage same specialty-only standard, no physical office required.